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CMH EMS Student Behavior Evaluation Form
Please rate the student according to the statements below. WHILE SCORING, PLEASE KEEP IN MIND THE STUDENT'S WORST PERFORMANCE, not the average or best performance.
Link to this form:
http://ozarksems.com/eval-behavior.php
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Assessor's name
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Choose
Carnes, Victoria
Aldridge, Owen
Cannon, Wayne
Choate, Benjamin
Alharbi, Abdulaziz
Carfield, Robert
Amorose, Mark
Anderson, Devoney
Burris, Amanda
Buckner, Allen
Aumiller, Matthew
Baker, Austin
Barnett , Bill
Barrett, Brandon
Cardwell, Aaron
Barrett, Cara
Bowman, Adelene
Bayer, Jim
Beasley, Jeffrey
Becker, Theron
Bernier, David
Burton, Nathan
Berscheid, Robby
Bizzaro, Francis
Boaz, Rick
Claxton, Jared
Collins, Sean
Cook, Candace
Cook, Logan
Cramer, Travis
Cromer, Levi
Cummings, Jim
Davis, Jack
Davis, Kevin
Dempsey, Olivia
DeWitt, Claire
Dickover, Amanda
Divine, Lloyd
Doherty, James
Dole, Kelly
Downs, Bill
Dungan, Joel
Estes, Jessica
Evans, Jonathan
Evans, Lora
Faxon, Kyler
Feldmeier, Markus
Ferguson, Tyler
Fisher, Robin
Flynn, Brice
Foster, Brandon
Frost, Ambyr
Gilfedder, Paul
Gohl, Rebecca
Gonder, Jason
Greer, Bradley
Griffin, Richard
Guynn, Dan
Hackett, Stanley
Hammer, Florian
Harrison, Brad
Hawkins, Renee
Higgins, Scott
Hilton, Jason
Holden, Nathan
Holstein, Zach
Howard, Eric
Hughes , Mike
Jenkins, David
Johnson, Aubrey
Jones, Comorgan
Keller, Steven
Kenall, Brandon
Keys, Kerry
Kluhsman, Raymond
Knierim, Jacob
Kroger, Scott
Lawler, Richard
Lewis, Tariq
Liberty, Tom
Long, Joseph
Lunsford, David
Malen, Chase
Matchett, Tyler
McCaslin, Andy
McDonald, Ryan
McKinnon, Matt
Meadows, Kyle
Merritt, Jesse
Mesey, Austin
Meuschke, Robert
Moore, Greg
Morton, Sarah
Murphy, Rebecca
Muse, Stephanie
Naugle, Bruce
OConnor, Brian
Ohrenberg, Matthew
Penick, Robyn
Perkins, Nic
Phillippe, Robert
Price, Jeremy
Privett, Adam
Pulley, Donal
Rice, Wes
Roberts, Alice
Rogers, Nathan
Rossiter, Jim
Rugen, Jeremy
Rupert, Joel
Ryan, Thomas
Sampson, Solonia
Sanchez, Karol
Scanlin, Russ
Schoester, Kristen
Schrader, Earl
Schulz, Kenny
Semans, Daryl
Semans, Kellee
Shoemaker, Sarah
Single, Joshua
Smith, Molly
Spooner, Trey
Staab, Bert
Stafford, Joshua
Stockstill, Colby
Storer, Luke
Swickard, Brent
Swihart, Fred
Test, Robert
Tracy, Michael
Trimble, Grant
Triplett, Sally
Tudor, Johnathan
Ulm, Steven
VanBecelaere, Adam
Walker, Luke
Weaver, Aaron
Whalen, Arnet
Wilson, Adam
Wood, Megan
Woodall, Sam
Young, Morgan
Student's name
*
Choose
Altic, Liz
Bennett, Brian
Bolen, Madison
Bush, Coley
Butler, Saige
French, Katee
Harman, Mayci
Horn, Chelsi
Hunt, Eli
James, Allison
Johnston, Bailey
Lukefahr, Madeline
McCormick, Lacey
Netherton, Julie
Pennington, Ryli
Peterson, Marie
Piper, Michael
Riegle, Colby
Schmidt, Eric
Sebastian, Krystin
Silkwood, Elizabeth
Vanbrummel, Katelyn
Williamson, Savanah
Wilson, Shelina
Yeargain, Jennie
Assessment date
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POSITIVE is being proud of who we are and proud of what we do by communicating with key words at key times (i.e. AIDET), taking pride in personal and facility appearance, and interacting with others professionally with smiles and kind words.
The student is POSITIVE
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Strongly disagree
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2
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5
Strongly agree
RESPECTFUL is treating everyone as a friend or family by respecting other's time, being sensitive to emotions, and communicating respectfully with words, tone, and body language.
The student is RESPECTFUL
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Strongly disagree
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2
3
4
5
Strongly agree
INNOVATIVE is encouraging new ideas and embracing change by seeking opportunities to be effective, efficient, and safe in providing high quality care, supporting advanced technology, and taking ownership of the team approach.
The student is INNOVATIVE
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Strongly disagree
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5
Strongly agree
DEDICATED is committing ourselves to improving the quality of life by taking personal responsibility and accountability, being fully engaged, and being determined to exceed expectations.
The student is DEDICATED
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Strongly disagree
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5
Strongly agree
EMPOWERED is taking pride in knowing what to do and how it makes a difference by just fixing it or making it better, being proactive on behalf of others, and encouraging our peers to be accountable.
The student is EMPOWERED
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Strongly disagree
1
2
3
4
5
Strongly agree
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